The cover of a book is chosen very carefully. Book publishers are very aware that it is one significant way in which people choose books. Authors, reputations, book clubs, yes, definitely. But covers too. Especially for a book that might be a little edgy or unknown. They inspire us to open the book, then maybe, to buy them.
Just recently, my best friend had her first (but not last!) book published. I was astonished at how many different versions of the cover we looked at. I was lucky enough that she shared them with me. Image after image, very different or just tweaked slightly.
A cover reflects the best of what’s inside. In one sense, it’s a teaser. It offers up the visual of what the book wants to say about itself.
That’s what we all do. We choose our clothes, hairstyle, make up, jewelry, car we drive and as much else as possible to reflect who we are or who we would like people to think we are.
When we feel that urge or pull to be parents and we are not, it’s very visible to the world. Easily enough commented on as well, isn’t it?
Infertility can be one of the most exposing, vulnerable diseases we will experience. It makes us vulnerable on so many levels. We often wear our hearts on our sleeves, hoping and praying that we will conceive, that our children will come to us.
While we’re waiting for them, though, it is clear to everyone that we are not parents. Our desire to have them, no matter how strong, is not usually as visible.
Might it be easier if there was some sign that let people know we were trying and wanted children and that there was no need to ask about it?
Perhaps, even better, a warning sign? In flashing neon? Don't ask!
I think that I was my most honest and vulnerable while I was trying to conceive. My yearning , hopefulness and strain all shone across my face at any given moment.There was a fundamental change that was trying to peek out.
It's clear when we are not parents yet. It makes us vulnerable. It forces the inside, the internal to be at peace with the external. They match perfectly, what we don't have and what we want.
As does having our children. Our insides and outsides match then too. With contentment and joy.
Fertility is about conceiving. Whether it's an idea, painting, business plan or a child. The definition from Webster's Dictionary is "1. To become pregnant with a child, 2. To take into one's mind; to devise, form a conception of, or imagine. 3. To apprehend by reason or imagination; to understand, 4. To think; suppose
We all reach those places in our lives where it's apparent there is a choice that must be made. The path divides. There are apparent paths, clean, well cleared. There are obviously untrodden paths that one has to look carefully to find and which are rather grown over.
And there are the pathless paths, the ones that don't exist until you clear the way.
When we come to that part of our life, or perhaps the many times that paths diverge and a choice needs to be made, how do we make the choice? What leads us down one path and not another? Is it a decision, an intuition, a well thought out previously
conceived plan, a message from a past life, a message from a past lover, is it closing your eyes; spinning around and walking blindly forward? How we make the choice can be vastly different each time we need to decide.
So we get to these points, pivotal, life changing, and we stand there, or we blunder ahead. Do we "take into one's mind, form a conception of, imagine, understand, think or suppose"? How we spend our time, our lives, our energy, our heart, those are the biggest decisions we make in our lives.
Sitting quietly is an option.
When I first started trying to conceive
, I imagined every month that I was pregnant
. I assumed that I probably was and started to feel pregnancy
symptoms. My breasts were more tender, I was slightly nauseous, less PMS symptoms, I felt or imagined that I felt them all. Every month, I figured out my due date, whose birthday the baby's would be near, what seasons I would be pregnant through. My periods were irregular, adding and enhancing the idea that maybe it was this month that I was pregnant.
Sounds incredibly naïve now, doesn't it? Naïve and slightly dumb, even. Remember though, it was 18 years ago that I discovered each month that I was wrong. Infertility wasn't discussed the same way that it is now, not on TV, not in the magazines, not on radio shows. Also, the field of reproductive endocrinology was so much newer and so much less effective. (The pregnancy rates for IVF were so much lower!)
After going through a year of ups and downs, hoping and feeling pregnant, getting my period and realizing that again, I was not, I started to look around. Luckily, for me, unluckily for her, my best friend was experiencing similar problems with conceiving. By the time that I went to an appointment with a fertility specialist, she had gone through a year or more of fertility treatment and was pregnant with her first son. It was a tremendous help to have a friend who knew the language, had experienced the feelings, taken the medications. Easy to speak with her, comforting to hear what she had to say because I knew she had experienced it herself.
I don't remember at what point I stopped assuming or feeling pregnant every month. I do know that there came a time where I knew, every month that I was not pregnant. I do know that there came a time that I knew I would never become pregnant and have a baby. I do know that shift, which felt equally as real to me, was like a storm cloud over my head. I picture Eyore, walking around with the cloud over his head, moving when he moves, pausing or stopping when he does. Head drooping, big sad eyes, tail down, assuming that nothing would ever be right, good, bright or happy again.
I don't remember either, when Pooh turned into a better character fit for me than Eyore. It was a slow evolution, I spent a long time trying to conceive, took quite a few breaks from active fertility treatment. There came a time though, while still trying to conceive, that I felt more peaceful, less doomed, less gloomy. At least for periods of time. Volunteering helped, no question (more about that on Monday!) that giving back, helping support other men and women experiencing infertility gave me a sense of purpose that made me feel more at peace. Pooh is like that, you know. More peaceful, calmer, more hopeful. The perfect yogi really. Or maybe a different version of Buddha. A wisdom that is apparent, silly and naïve as Pooh can sometimes be.
And so, I think, I came to a new place. Not traveling in a circle, arriving back where I started from, assuming I was pregnant every month. Even in a circle, the journey teaches us something each loop around. No longer naively assuming that I was pregnant or even that I would become pregnant that month but also no longer gloomily assessing that I would never become pregnant.
A more peaceful resting spot. My Pooh moments were precious to me, those moments of calm, of clarity, that things were ok, just as they were. Yes, even in the middle of an IVF cycle being cancelled, even during the interminable two week wait after transfer.
As much yoga as I practice now, I realize that my Pooh moments of almost twenty years ago were my real introduction to the practice of yoga. Being present in the moment and knowing that everything is ok, for this breath, for this moment.
And this one too.
is the diagnosis in about 60% of the couples that we see in our practice. Many of the patients we see here easily achieve pregnancy with their first child and are struggling to conceive their next child. Unfortunately, because of the shock and disbelief that they experience in not achieving a natural pregnancy on their own after achieving the first one easily, they often delay reaching out for help.
I truly wish there was a way that we could educate patients that there can be nothing wrong with them, simply that they need some help. I often feel that there is a sense that admitting you are infertile brings shame to patients and it is this admission that prevents them from coming to the office sooner. Just like someone who takes blood pressure medication at their diagnosis of high blood pressure, we want couples to be willing to use fertility therapies if they are diagnosed with subfertility. What patients need to realize, and I hope can realize, is that coming to the practice sooner rather than later, (preferably after 6 months of trying if someone is over 35) increases their chances for the practice to be able to help them conceive.
Age-related decline in fertility is the most common factor that we see in our Connecticut practice. The decline in fertility affects both men and women. Approximately 30 to 40% of our patients have male factor, (some problem with sperm or production) as a contributing cause to their subfertility. Achieving a pregnancy in the later 30's for many women is contrary to their own biology and it is not unusual for the human female to need assistance in this matter. That is why we are here. (In general, the diagnosis of subfertility is attempting pregnancy for 6 months without success.)
It is important for patients to realize that the months and sometimes years they spend trying on their own could often be circumvented. Not all therapy involves in vitro fertilization. In fact, we often start with the lowest tech therapy and see that with a small amount of help, people can become pregnant.
When patients simply ask for help and move forth with the process of moderate infertility therapy, we have great success. Our world has changed in that people have delayed childbearing into their 30's versus as little as 50 years ago, when women were having children primarily in their 20's. Therefore, they are often trying to attain their second or third pregnancy in their mid to late 30s. It is these patients that are being negatively affected by the biological clock. The biological clock is the expression of the normal decline in fertility that every women experiences between 35 and 45.
The other factor that is often an expression of the biological clock is having multiple miscarriages, which are both physically and emotionally demanding and exhausting. This issue also warrants a visit to their reproductive endocrinologist's office for workup and assistance and is often overlooked as an area in which we can help.
I realize that no one truly wants to come to this office but maybe it will help to understand that we cherish the work that we do; helping grow families. Hopefully, knowing that we care about patients throughout the process can make coming feel more comfortable.
I welcome comments or questions on this topic.
Mark P. Leondires, MD
Medical Director of Reproductive Medicine Associates of Connecticut (RMACT)